Ying Zheng

Using Machine Learning to Predict the Prognosis in Endometrial Cancer Patients Undergoing Fertility‐Sparing Treatment

ABSTRACT Background Endometrial cancer is a significant gynecological malignancy with rising incidence among women of reproductive age, necessitating effective fertility‐sparing treatments. Machine learning offers potential in enhancing prognostic assessments through radiomics. Objective To develop and validate a machine learning‐based model integrating radiomics and clinical features to predict the prognosis of fertility‐sparing treatments in endometrial cancer patients. Methods This retrospective study included 102 endometrial cancer patients who received fertility‐sparing treatment at West China Second University Hospital from November 2017 to December 2023. Patients were randomly divided into training ( n  = 81) and testing ( n  = 21) cohorts. The primary outcome was 6 month treatment response evaluated by endometrial sampling. MRI‐based radiomic features and clinical data were analyzed using logistic regression and other machine learning algorithms. A combined model was constructed by incorporating radiomics and clinical features. Model performances were assessed by the area under the receiver operating characteristic curve (AUC) analysis, and decision curve analysis (DCA) was used to estimate the models' clinical values. Results Among 102 patients, 60 (58.8%) achieved complete remission (CR), whereas 42 (41.2%) did not (non‐CR). In total, 1197 radiomic features were extracted from MRI images. Thirteen radiomic features were deemed valuable by dimensionality reduction and selection. Among radiomic models, the logistic regression model was the most effective, showing high stability and accuracy, with AUCs of 0.875 in the training cohort and 0.852 in the test cohort. Ultimate clinical features selected by univariate and multivariable logistic regression constructed a clinical model. The combined model demonstrated superior performance with an AUC of 0.941 in the training cohort and 0.907 in the testing cohort. Combined model DCA revealed optimal clinical efficacy. Conclusion The integrated model effectively predicts fertility preservation outcomes, offering a reliable noninvasive tool for clinicians. This approach may enhance personalized treatment strategies for young endometrial cancer patients.

A single-site laparoendoscopic surgery for endometrial cancer (stage IA, G3): Effective suturesuspension skills and conservative management of chylous fistula

Sentinel lymph Node mapping versus systematic pelvic lymphadenectomy on the prognosis for patients with intermediate-high-risk Endometrial Cancer confined to the uterus before surgery: trial protocol for a non-inferiority randomized controlled trial (SNEC trial)

Sentinel lymph node (SLN) mapping has been recommended as an alternative staging approach to lymphadenectomy for apparent uterine-confined endometrial cancer (EC). However, the prognostic value of SLN mapping alone instead of systematic lymphadenectomy on EC patients remains unclear. A multi-center, open label, non-inferiority randomized controlled trial has been designed to identify if SLN mapping alone is not inferior to pelvic lymphadenectomy on prognosis of patients with intermediate-high-risk EC clinically confined to uterus. Eligible patients will be 1:1 randomly assigned to accept SLN mapping or pelvic lymphadenectomy. The primary endpoint is the 2-year progression-free survival (PFS). The second points are the 5-year PFS, 5-year overall survival, surgery-related adverse events and life quality. A total of 780 patients will be enrolled from 6 hospitals in China within 3-year period and followed up for 5 years. ClinicalTrials.gov Identifier: NCT04276532.

Comparison of robotic and conventional laparoendoscopic single-site hysterectomy for large uterus using da Vinci Xi system: A propensity score matching analysis

The robotic surgical system equipped with enhanced visualization, flexible instruments, tremor filtration, and improved ergonomics can greatly address difficulties encountered in conventional laparoendoscopic single-site surgery. This study aimed to evaluate whether robotic laparoendoscopic single-site surgery performed by da Vinci Xi system was an optimal approach in performing benign hysterectomy for large uterus. This was a single-center retrospective cohort study. Between May 2021 and September 2023, patients who underwent transumbilical single-site hysterectomy with or without da Vinci Xi system indicated for uterine myoma or adenomyosis with uterine weight exceeding 280 g were enrolled. After conducting propensity score matching to balance the baseline characteristics, perioperative outcomes were compared between the two groups. After 1:1 propensity score matching, 74 patients were included in each group. No patient required additional ports, conversion to laparotomy or multi-port laparoscopy. The robotic group showed significantly longer exhaust time (2.4 ± 0.7 vs 2.0 ± 0.7 days, p < 0.001) and lower postoperative complication rate (4.1 % vs 13.5 %, p = 0.042) compared to the conventional group. No significant differences were found in operative time (183.6 ± 53.6 vs 178.2 ± 55.4 min, p = 0.546), blood loss (100.0 vs 50.0 mL, p = 0.296) and intraoperative complication (1.4 % vs 0, p = 1.000) even though the robotic group had heavier uterine weights (412.5 vs 394.0 g) and a higher rate of severe adhesion (33.8 % vs 17.6 %). Robotic and conventional laparoendoscopic single-site hysterectomy for large uterus were both feasible and safe with satisfying surgical outcomes. However, the laparoendoscopic single-site surgery was easier to be mastered and more likely to handle challenging conditions with assistance of da Vinci Xi system.

Primary debulking surgery for advanced epithelial ovarian cancer with isolated enlarged para-aortic lymph node by robotic transumbilical single port approach

Successful pregnancy and delivery in a 28-year-old patient with ovarian gynandroblastoma treated by the fertility-sparing method

An advantageous technique for fertility sparing staging surgery of epithelial ovarian cancer with a single umbilical incision

Para-aortic and Right Obturator Lymphadenectomy for Surgical Staging of Advanced Cervical Cancer through the TU-LESS Extraperitoneal Approach

To present an innovative transumbilical laparoendoscopic single-site (TU-LESS) extraperitoneal approach for lymphadenectomy in a patient with advanced cervical carcinoma. Demonstration of the novel technique through video. In advanced cervical cancer, determining the status of the para-aortic lymph nodes is essential because extended-field radiologic therapy is recommended for a patient with positive para-aortic lymph nodes [1]. Nonetheless, the sensitivity and specificity of currently available imaging workup for positive lymph nodes are limited. Surgical staging enables precise evaluation. However, laparotomy has potential wound complications and leads to treatment delay. Multiport laparoscopic transperitoneal and extraperitoneal approaches limit surgeons' ability to reach the para-aortic area or obturator fossa in the same operation [2]. Thus, we take full use of these approaches' advantages and avoid their disadvantages to design a promising minimally invasive surgery approach [3]. Para-aortic and obturator lymphadenectomy through the TU-LESS extraperitoneal approach was successfully performed without complications. The patient recovered quickly and received subsequent concurrent chemoradiation on schedule. TU-LESS extraperitoneal para-aortic lymphadenectomy provides satisfactory exposure and easy access to both the para-aortic area and obturator fossa. In addition, the bowels are uplifted by an extraperitoneal air cushion to achieve excellent exposure and reduce the risk of bowel injury. With quick recovery, the patient could start accurate radiation treatment promptly.

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as treatment for upper vaginal leiomyoma

Abstract Introduction: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging technique in the area of minimally invasive surgery. Vaginal leiomyoma is a rare benign tumor, with only a few cases being reported in the literature. we demonstrate a novel approach for excision of a vaginal leiomyoma via vNOTES. To ensure reproducibility and replicability akin to a standardized procedure, we have provided a step-by-step video description of the use of vNOTES for upper anterior vaginal myomectomy. Patient concerns: A 35-year-old female (G2P0A2) presented with a tumor in the upper anterior vaginal wall, which gradually increased in size. Diagnosis: A vaginal examination revealed a swollen area approximately 3-cm in diameter on the upper anterior vaginal wall. The swelling was mobile and solid. All other vitals were normal. Transvaginal ultrasound detected a 3.0 × 3.4 cm hypoechogenic mass on the superior vaginal wall, and a preoperative diagnosis of the vaginal tumor was confirmed. Interventions: The upper vaginal leiomyoma treated using transvaginal natural orifice transluminal endoscopic surgery. Outcomes: The procedure lasted for 20 min, and the postoperative course was uneventful. Conclusions: vNOTES can be a promising alternative to traditional vaginal surgery for upper vaginal disease due to advantages such as excellent exposure, easy access and precise suturing. However, more studies are needed to assess its long-term efficacy.

Laparoendoscopic Single-site Radical Hysterectomy with Vaginal Closure and without Uterine Manipulator for FIGO IB1 Cervical Cancer

Minimally invasive surgery (MIS) for radical hysterectomy (RH) has been reported with inferior oncologic outcomes in the New England Journal of Medicine [1,2]. Some studies have suggested that the no-touch technique may be a useful procedure to prevent tumor spillage and improve survival. Therefore, we performed RH targeting early-stage cervical cancer using the laparoendoscopic single-site (LESS) approach with an enclosed colpotomy and without a uterine manipulator [3]. Video demonstration of the technique. A hospital. A 48-year-old postmenopausal woman received a diagnosis of stage IB1 (International Federation of Gynecology and Obstetrics, 2018) cervical cancer [4]. After being fully informed of the benefits and risks of different surgical approaches (laparotomy and MIS), she consented to the MIS. The type C RH through the LESS approach was performed successfully. The final pathologic findings confirmed stage IB1 cervical carcinoma. The patient recovered quickly, albeit with slight pain, and the incision scar was hidden perfectly for cosmetic purposes. This video demonstrates that LESS-RH with vaginal closure and without a manipulator is feasible and safe. Suspension skills played a significant role in LESS-RH. In addition, this surgical procedure involved 4 specific techniques to prevent tumor spillage: creation of a vaginal cuff, avoidance of a uterine manipulator, standard type C radical hysterectomy, and bagging of the specimen. These adaptations were meant to minimize tumor manipulation and disruption for reducing the increased risk of recurrence. However, further verifications are still required.

Laparoendoscopic Single-site Radical Hysterectomy: Sufficient Exposure via Effective Suspension

To perform a radical hysterectomy for early-stage cervical cancer through laparoendoscopic single-site (LESS) approach and demonstrate if the effective suspension could achieve different exposed purposes and space extension. Presentation of the surgery through this technical video. Hospital. A 52-year-old menopausal woman who presented with postcoital bleeding for 3 months was diagnosed with poorly differentiated (G3) cervical squamous cell carcinoma with International Federation of Gynecology and Obstetrics stage IB1. The patient was carefully consulted about the oncologic risks of the different surgical approaches; thereafter, the LESS approach was decided with informed consent. The LESS procedures for staging surgery were completed. The estimated blood loss was 60 mL, and operation time was 250 minutes. Results of the pathology report showed G3 squamous cell carcinoma and no pelvic lymph nodes metastases. The Foley catheter was removed on the 21st day, and the bladder function recovered completely after removal. She was followed up for a year without any evidence of recurrence or complications. Because of technical difficulties with a limited number of hands, complex surgeries, such as radical hysterectomy, have rarely been performed using the LESS approach [1]. The dissection of vesicocervical and parametrial space is critical to radical hysterectomy, and inadequate exposure to these spaces during the procedure presents major difficulties [2]. In the video, surgery for cervical cancer was performed successfully and met the International Federation of Gynecology and Obstetrics' standards for type C radical hysterectomy. Our video demonstrated that the varied and flexible suspension played a significant role in providing clear vision and sufficient exposure; furthermore, it was feasible, effective, and safe in the LESS approach [3,4].

Placement of robotic single-site surgery with the tumor-free technique for early cervical cancer using the da Vinci Xi platform